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Ideomotor Apraxia: The Burden of Intentional Movement

Neurologist Dr R. sits with Mr J., a 48-year-old photographer who’d recently suffered a stroke, in his office. Dr R. asks Mr J. to demonstrate a waving motion as if he were saying hello, to which he attempts with some difficulty. When asked to point towards the ceiling, Mr J. again encounters difficulties as he finds himself clenching and unclenching his fist. Dr R. proceeds to hold his hand out in front of him with his palm facing the floor. “Try to imitate the movement,” he asks. With deliberate effort, Mr J. eventually manages. “That’s good!” praises Dr R, “Now turn your hand over.” Mr J., with increased frustration, gives this a try – only to begin repeatedly slapping his hand against his thigh instead.

Mr J. is clearly trying to reproduce the movements that are asked of him, so what’s stopping him? Is it a generalised motor problem? This does not appear to be the case; as he’s asked to remove his glasses, Mr J. smoothly proceeds, and when asked to hammer a nail into a block of wood, Mr J. ably fulfills the request.

What Mr J. appears to suffer from is apraxia, “the difficulty in carrying out purposeful movements, in the absence of paralysis or muscular weakness” (Carlson, 2010). However, Mr J’s condition is a specific form of apraxia: ideomotor apraxia, whereby goal-directed movement is impaired – patients understand how to perform movements, but cannot carry them out. In this capacity, timing, sequencing, and spatial organisation of gestures are interrupted (Rothi & Ochipa, 1991). An example of a spatial error would be where, if the patient were asked to imitate brushing their teeth, they would use their fingers to represent the toothbrush (body-part-as-object substitution), or close their fist so tightly that there is no space for the imaginary toothbrush (orientation error). Interestingly, patients are still able to perform automatic actions when cued – this is known as the automatic-voluntary dissociation. Patients can use a telephone if they hear the phone ring, for example. This deficit, therefore, is less obvious in everyday life compared to in a clinical setting.

Ideomotor apraxia typically arises due to damage in the left parietal association areas and white matter bundles from the frontal and parietal association areas (Zadikoff & Lang, 2005). More rarely, other areas may also be involved such as the premotor and supplementary motor cortex, basal ganglia, and thalamus. Indeed, Dr R. states in his report, “The left parietal lobe is involved in the control of movements – especially sequences of movements – that are not dictated by the context. Thus, he finds it almost impossible to follow verbal requests to make arbitrary movements”. More specifically, Rushworth et al. (1997) suggest that the impairment in movement sequencing may be a result of a difficulty in redirecting motor attention from movement to movement in the sequence.

Although Mr J.’s motor independence was not as proficient as before, his apraxia is unlikely to have impacted his daily activities because patients are still able to respond to automatic actions that are cued. Nonetheless, speech and physical therapies and biofeedback exist to help patients regain some control (Smania et al., 2006; McNeil et al., 1976; Wambaugh et al., 2006). More interestingly, there is evidence to suggest that right hemispheric structures in the brain could compensate for the damage in left hemispheric structures which have led to motor problems (see Wheaton & Hallett, 2007).  For example, the plasticity of higher brain areas may allow for the reorganisation of left parietal and premotor cortices with experience, and the relearning of certain activities that were previously reliant on the damaged areas (Kim et al., 2004). However, the mechanisms underlying this are not fully understood and we cannot completely determine whether the brain could compensate for the functions lost in apraxia.

This article was written by Manying Lo and edited by Robert Vilkelis. Both of them are members of the Bugle team.

References:

Carlson, N. R. (2010). Physiology of Behavior. Boston: Allyn & Bacon.

Kim, D. E., Shin, M. J., Lee, K. M., Chu, K., Woo, S. H., Kim, Y. R., & Roh, J. K. (2004). Musical training‐induced functional reorganization of the adult brain: Functional magnetic resonance imaging and transcranial magnetic stimulation study on amateur string players. Human Brain Mapping, 23(4), 188-199.

McNeil, M. R., Prescott, T. E., & Lemme, M. L. (1976). An application of electromyographic biofeedback to aphasia/apraxia treatment. In Clinical Aphasiology: Proceedings of the Conference 1976 (pp. 151-171). BRK Publishers.

Rushworth, M. F., Nixon, P. D., Renowden, S., Wade, D. T., & Passingham, R. E. (1997). The left parietal cortex and motor attention. Neuropsychologia35(9), 1261-1273.

Smania, N., Aglioti, S. M., Girardi, F., Tinazzi, M., Fiaschi, A., Cosentino, A., & Corato, E. (2006). Rehabilitation of limb apraxia improves daily life activities in patients with stroke. Neurology67(11), 2050-2052.

Wambaugh, J. L., Duffy, J. R., McNeil, M. R., Robin, D. A., & Rogers, M. A. (2006). Treatment guidelines for acquired apraxia of speech: A synthesis and evaluation of the evidence. Journal of Medical Speech-Language Pathology14(2), xv-xv.

Wheaton, L. A., & Hallett, M. (2007). Ideomotor apraxia: a review. Journal of the Neurological Sciences, 260(1), 1-10.

Zadikoff, C., & Lang, A. E. (2005). Apraxia in movement disorders. Brain128(7), 1480-1497.

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The Echo Chamber: Is Social Media to Blame?

With the recent inauguration of Donald Trump and the results of the Brexit referendum, alongside a growth in support for parties like UKIP, it seems that populations of voters are becoming more extreme in their political views.

Recent theories have attributed this greater polarisation of groups to the ‘echo chamber’ effect in political opinions shared on social media. This suggests that the information we receive on our news feeds does not provide us with a diverse array of opinions or viewpoints. Instead, our feeds are tailored so as to provide us with information concurrent with our own political views. The echo chamber refers to the idea that information we put out on social media is repeated and reflected back by those within our communities, whilst contrasting views are ignored and limited.

As social media sites, such as Facebook, are the primary sources of political news information for Millennials (Mitchell et al., 2015), it has been suggested that the limited spectrum of news that we engage with is reducing the discussion that underpins democracy and political debate.

This may also predict problems in the future: if people’s political views are being mirrored on social media, they may perceive that view as the norm across the whole country. This has been used to explain why so many voters were sure that the results of the Brexit referendum or the American election would go in one direction, with some even choosing not to vote on account of this certainty, just to receive an unwelcome shock when their assumptions were mistaken. Could all this be a result of limited information, lulling social media users into a false sense of security in the belief that their view is shared by voters on a national or global level?

Whilst many have pointed the finger at the algorithms and cookies that social media sites use to adapt the information available to the user, in order to remain relevant or appealing, it is worth exploring whether this chamber is partly constructed as a result of our own choices. Social Identity Theory (Tajfel & Turner, 1979) highlights an innate desire to belong to social groups, with pride and self-esteem gained from doing so. However, this can lead people to start discriminating between group members and outsiders. The desire to enhance one’s own self-esteem leads to an ingroup bias: tending to perceive ingroup members more favourably and derogating or belittling outgroup members. This could explain a desire in people to form groups with those on social media who share similar political views, thus communicating mostly with them, valuing their opinions and negating alternative views. This, therefore, begs the question: is the information presented to us limited by technology, or is social media simply a new platform for us to selectively expose ourselves to information that reinforces our need for group belonging?

This article was written by Emily Weigold and edited by Emma Keoy. Both of them are members of the Bugle team. 

References:

Mitchell et al. (2015). Facebook top source for Political News amongst Millennials. Retrieved from: http://www.journalism.org/2015/06/01/facebook-top-source-for-political-news-among-millennials/

Tajfel, H., & Turner, J. C. (1979). An integrative theory of intergroup conflict. The social psychology of intergroup relations33(47), 74.

Say Yes to The Mess

This article was inspired by Tim Harford’s talk on “The Importance of Being Messy”, an Intelligence Squared Debate, 6th Dec. 2016

Economist Tim Harford puts forth a compelling case to put our autopilot selves on hold occasionally, and embrace the unexpected. While we derive comfort and efficiency from organization and structure, Harford proposes that structure doesn’t always help us get the best out of our abilities, that randomness and chaos force us to become the best versions of ourselves in extenuating circumstances – such as pianist Keith Jarrett’s concert in Cologne, where he gave one of his most powerful performances on an untuned rehearsal piano. Oppenheimer and colleagues (2010) carried out a study on ‘desirable difficulties’ as mechanisms to improve exam performance of students. They found that changing the font of the study material to something relatively uncommon or difficult (think comic sans ms or Ar Decode) helped those students score better than the ones who read the material in more typical fonts like Times New Roman. ‘Complex’ fonts increased attention and slowed their pace of reading, thus leading to more in-depth retention of the material.

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Postgraduate Application Guide (PAG) #4: Work Experience and Future Careers

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As the field of academia gets increasingly more competitive, it becomes harder to impress the admissions office: there are too many intelligent people out there nowadays, so good grades alone just don’t cut it anymore. This is where work experience comes in. Not only does it enable your application to stand out, but also demonstrates your maturity, responsibility, commitment and many other important qualities that make you a worthy applicant. So, work experience is pretty much a necessity for an aspiring psychologist, but you probably already know this from all the careers lectures you had to sit through during your time at UCL. So, what can postgrads advise when it comes to work experience?

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Postgraduate Application Guide (PAG) #3: Interviews and Funding

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Apart from the degree application, the subsequent interview process and the application to relevant funding sources and scholarships are important steps to be taken. Below are some tips and personal experience from various postgraduate students on how to prepare for an interview and secure funding will be covered.

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Postgraduate Application Guide (PAG) #2: CV and Personal Statement

personal-statement2

Academic achievements are undeniably important for applying to postgraduate courses. However, with an imperfect transcript, your CV and personal statement may just be your saving grace. Here, we  provide a guide on what makes a successful CV and personal statement.

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Postgraduate Application Guide (PAG) #1: Introduction to our Postgrads

 

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As the application season is now in heat, we decided to work on a project on postgraduate applications to help our readers currently applying to courses. We interviewed six current and former UCL Masters and PhD students in Psychology-related fields about their applications process. In this project, we will cover academic CVs and personal statements, interviews and funding, as well as desirable experience and prospects after graduation. In this opening post, we will introduce our interviewees and provide a glimpse into why they chose their degree programmes.

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What The Duck: The Science of Swearing

shark-cartoon-89

When I was younger, I had a copy of Even More Terrible Tudors by Terry Deary which I read cover to cover more times than I’d like to admit. One of the historical titbits I found very entertaining was how a school friend of Edward VI was apparently punished by a teacher for proclaiming “thunderous oaths!”—evidently incredibly rude at the time. Obviously, centuries later, we’ve moved on—but we haven’t moved beyond rude words and being punished for using them. Arguably, swear words are a necessary part of language: they’re universal to all cultures and their meaning is often immaterial; it’s the emotional state their use expresses that’s important.

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States Of Mind: History in Review

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Goshka Macuga, ‘Somnambulist’ (2006), courtesy the artist and Kate MacGarry. Source

I went to see ‘States of Mind’ at the Wellcome Collection in October, and I left feeling amazed, educated and inspired. The exhibition brought together works of artists, psychologists, philosophers and neuroscientists, exploring phenomena such as somnambulism (sleepwalking), synaesthesia (a sensation in one of the senses, such as hearing, triggering a sensation in another, such as taste) and memory disorders, interrogating our understanding of the conscious experience.

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Mental Health in Media

poohBy: Manying Lo (Bugle Team)

Edited by: Emma Keoy (Bugle Team)

Recently, the Bedford Bugle team visited the Welcome Collection to view the ‘Bedlam: the asylum and beyond’ exhibit. The exhibition aimed to capture and re-imagine what early institutions were like for the mentally ill through various artworks and testimonies by the doctors and patients themselves. Some of the abstract art appeared to represent how disorganised and nonsensical the thoughts of some of the patients could be. The representation of the relationship between a patient and their mental illness through art made me think about the representation of mental illness in other forms of media.

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The White Male Effect: Why They’re Fearless

prince

By: Emily Weigold (Bugle Team)

Edited by: Emma Keoy (Bugle Team)

Long told in traditional folk lore, in stories of lands far, far away and in every bestselling Disney movie, men are fearless. Women worry, tremble and fret but men are bold and men ultimately save the day. Although we may now dismiss this as a product of old, patriarchal attitudes, embracing the potential for both fearless heroes and heroines, psychological studies may allude to an element of truth in the intrepid male aesthetic.

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Do Animals Use Language?

talking

By: Helice Stratton (Bugle Team)

Edited by: Emma Keoy (Bugle Team)

It goes without saying that the media have a habit of exaggerating the findings of scientific papers. If a journal publishes evidence that starlings may be able to statistically analyse segments of speech—similar to how human infants begin segmenting words (Gentner, Fenn, Margoliash et al. 2006)—an article will likely surface claiming in bold, capital letters: “STARLINGS CAN LEARN TO SPEAK??”. It is understandable we’re so excited to find evidence that animals have some kind of language though—aside from lending credence to the Disney films we watched growing up. Logically, language must have evolved somehow, but we don’t yet know how. Did our mouths, throats and brains evolve to accommodate it? Or was it just adapted from pre-existing physical and cognitive systems? Finding buildings blocks for language in other species will give us a deeper understanding of how our own language instinct evolved.

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What Influences Music Taste?

By: Tarisa Tan (Bugle Team)

Have you ever listened to a song so good that you had to stop whatever you were doing and pay your undivided attention to the lyrics or general rhythm? Maybe you even felt goosebumps as you tried to get your groove on. It’s a wonder how music has that effect on us. It’s been the case at both individual and group levels. From Beatlemania to Beliebers, music clearly has the power to unite people. They’ve brought people together over a mutual love for music.

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Is Thought Governed by Language? Determinism Vs Relativity

100-words-for-lawn-cartoon

By: Chatrin Suksasilp (Bugle Team)

Edited by: Robert Vilkelis (Bugle Team)

One of the more intriguing – if not outright fascinating – claims made by the enterprise of linguistic and anthropological study is that the language you speak determines the thoughts you have. Anyone acquainted with the study of Language would probably recognise this proposition as the Linguistic Determinism or Sapir-Whorf Hypothesis. Dig a little deeper, and you find yourself in a niche of inquiry far more controversial than you’d bargained for.

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Merging Psychology and Neuroscience?

Teamwork and Leadership with education symbol represented by two human heads shaped with gears with red and gold brain idea made of cogs representing the concept of intellectual communication through technology exchange.
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By Dominika Leitan (Bugle Team)

Psychology as we know it today has only been practiced for around 70 years, which is nothing compared to other scientific fields. In human terms, math is elderly; physics, chemistry and biology are middle-aged, and psychology is essentially a toddler. As a result, we are only now starting to make our first steps towards the ‘right’ approaches to studying the mind.

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